How to Dismantle the NHS in 10 Easy Steps: The Blueprint That The Government Does Not Want You To See

Praise for the First Edition

The fight to maintain the NHS as a public service is one of the most fundamental battles we face today in our struggle for a British society that works for the many.

This wonderful, sobering book details how governments have teamed up with corporate and financial elites in an underhand effort to privatise and dismantle the NHS. Crucially, it also proposes solutions for how we can reclaim our NHS and the critical role of the grassroots groups leading this fight we can and must win.

Jeremy Corbyn, Leader of the Labour Party

The Tories are remorseless in undermining the founding principles of the National Health Service. Youssef is a practising NHS doctor, who has seen the attacks at first hand. His book is an essential weapon in our fightback.

Ken Loach, Film director

Like an increasing number of British doctors, El-Gingihy has gone through disbelief, anger and radicalisation at what he sees as the inexorable privatisation of our public health service… … … … . . How to Dismantle the NHS in Ten Easy Steps (is) an attempt to translate the changes into plain English… … . El-Gingihy’s account is enlivened by his experience as a GP serving some of London’s poorest patients

Richard Godwin, Evening Standard

How to Dismantle the NHS in 10 Easy Steps is a precise and devastating explanation of how a public health service - long the envy of the world - is furtively being dismembered for private, corporate gain by the likes of Virgin, Serco et al. The facts laid bare by El-Gingihy cry out for resistance. Arm yourself with this succinct book.

New Internationalist

Youssef El-Gingihy’s accessible short book shows us why this attack on our most cherished public service is so important - a process that has been underway since the 1980s under Margaret Thatcher. Youssef provides a wealth of quite incredible information in 71 pages, so if you ever find yourself faced with a Tory offensive, you will be ready for the fight. And it’s not just a Tory problem, El-Gingihy shows that every government over the past thirty years has contributed to the demise of the pride of the UK.

Nye Bevan, the creator of the service once said, ‘The NHS will exist as long as there are folk left with the faith to fight for it.’ El-Gingihy’s book provides us with plenty of ammunition for that fight.

Cameron Panting, Counterfire

El-Gingihy is a GP in east London. His commitment to the NHS and the NHS ethos of compassion and caring shines through. Step by step, El-Gingihy takes us through the path to the destruction of the NHS, charted not just by the Tories but by New Labour as well. This book is an accessible account of the complexity of 25 years of attacks on the NHS, and tremendously valuable for that.

Gill George, RS21 Magazine

Packed with facts and figures, this shocking book reveals how the ruling class is dismantling our most precious institution, with impunity. At once infuriating and motivating, it is vital reading.

Feyzi Ismail

Let’s imagine something almost unimaginable. The leadership of a country with the world’s finest health system, the pride of the nation, decides to dismantle it and replace it by the system that is by far the most costly, bureaucratic, and ineffective in the developed world, apparently under the influence of rigid doctrine (and perhaps greed). Unimaginable, but it appears to be happening, so Youssef El-Gingihy argues, all too persuasively, in his review of the steps being taken to convert the NHS to the failed US model.

Noam Chomsky

The campaign to undermine the NHS is often concealed in Orwellian euphemisms. Dr Youssef El-Gingihy breaks through this web of deceit with this excellent primer of the who, what, where and why your Health Service is being stolen from you.

John Pilger, investigative journalist and filmmaker

First published by Zero Books, 2019

First published by Zero Books, 2019

Zero Books is an imprint of John Hunt Publishing Ltd., No. 3 East St., Alresford,

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Text copyright: Youssef El-Gingihy 2018

ISBN: 978 1 78904 178 1

978 1 78904 179 8 (ebook)

Library of Congress Control Number: 2018949690

All rights reserved. Except for brief quotations in critical articles or reviews, no part of this book may be reproduced in any manner without prior written permission from the publishers.

The rights of Youssef El-Gingihy as author have been asserted in accordance with the Copyright, Designs and Patents Act 1988.

A CIP catalogue record for this book is available from the British Library.

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Contents

Foreword to the Second Edition

Introduction

Step One: Create an Internal Market

Step Two: Introduce Public-Private Partnerships

Step Three: Facilitate the Corporate Takeover AKA Organise a Great Big Sell Off

Step Four: Install a Revolving Door

Step Five: Run A PR Smear Campaign

Step Six: Legislate for the Dismantling of the NHS

Step Seven: Plot against the NHS

Step Eight: Brew the Perfect Storm

Step Nine: Redesign the Workforce

Step Ten: Restructure the NHS into a US-style Insurance System

Afterword: How to Save the NHS in 5 Easy Steps

Reading List

References

DEDICATED TO ALL THOSE WHO HAVE FOUGHT FOR THE NHS AND TO A FUTURE NHS FOR ALL TIME

I would like to thank those who showed the way and illuminated my understanding of what has been happening to our NHS. It is only through their contribution that I have been able to write this book. All those years ago, they were lone voices. More people are becoming aware of the marketisation and privatisation of the NHS and are determined to fight against vested interests to preserve it.

FOR ALI, AZZA AND JANA

Foreword to the Second Edition

‘Events, dear boy, events,’ as Prime Minister Harold Macmillan reportedly once said. Events have indeed overtaken the first edition of this book. The junior doctors’ strike, the Conservative victory in the 2015 general election, the Corbyn phenomenon, the unexpected Brexit vote and the arguably even more unexpected loss of the Conservative majority in 2017.

As a medical student and junior doctor, I was largely unaware of what was happening to the NHS. The NHS is no longer a publicly provided and owned health system but instead has become a market system. It is in the process of becoming a two-tier system with the expansion of private healthcare insurance for those who can afford it and a third class US Medicaid style threadbare safety net for those who cannot.

My awakening came with the Health and Social Care Act 2012 under the Conservative led coalition government. I realised that the government and the mainstream media were not informing the public of the implications of these reforms. I decided to write this book in order to communicate to the public in concise, accessible terms what is really happening.

In the months that followed the publication of my book in 2015, I found myself embarking on a journey that I had scarcely even contemplated when I set out to write it. Only weeks after publication, I was given a life-threatening diagnosis at the age of 34 and underwent several months of intensive treatment. Fortunately I went on to make a good recovery all thanks to the NHS. From fighting to save the NHS, the NHS saved my life. One dreads to think of the financial costs of such treatment in a private insurance system. A 2009 Harvard University study found that the majority of personal bankruptcies in the US - over a whopping 60 per cent - were due to healthcare costs.

At the outset of my illness, 50,000 junior doctors initiated strike action in protest at the government imposition of a new contract. It would turn out to be the largest industrial action of the twenty-first century in the UK. I even found myself thrust on to centre-stage in Parliament Square when I had the privilege of being invited to address the large crowds. Astonishingly I had received the first dose of my treatment the day before. I had expected to be laid up in bed that weekend; perhaps the mobilisation of my colleagues had served to invigorate me (I may have overdone it because things went downhill for the rest of that week!).

The junior doctor struggle was nothing less than living, breathing history being made even if it ended with a whimper rather than a bang. Of course, the lessons of this failure - some of them difficult to confront - must be evaluated if we are to rescue a publicly funded, provided, owned and accountable NHS. There have certainly been times when I have doubted my own analysis. One occasionally pauses to think that surely the government cannot be dismantling our precious, cherished NHS. Yet nostalgia will not be sufficient to salvage the NHS from the encroachment of market forces and the logic of capitalism. (Incidentally, the phrase - dismantling the NHS - appears to have entered the lexicon.)

One by one, I was saddened yet unsurprised to find my predictions coming true - the redesign of the workforce through the new junior doctor contract offering worse pay and conditions and the withdrawal of the student nursing bursary, the creation of economies of scale through chains of super hospitals and networks of GP surgeries ready for corporate takeover and the restructuring of the NHS into US-style accountable/integrated care organisations.

My journey has taken me from street demonstrations to the corridors of power in Westminster. I have met patients, campaigners, MPs, health correspondents, current as well as former civil servants, health ministers, shadow health teams and party leaders. What has perhaps impressed itself upon me most is how few have really grasped the direction of travel. I recall sitting in on a parliamentary Health Select Committee dismayed that nobody in the room appeared to fundamentally understand health economics or public health policy.

Policy has been concentrated in the upper echelons of the political, corporate and financial elite. This is a fundamental inheritance of the New Labour and Cameron eras. The culling of the civil service as a body of expertise has nullified institutional resistance. Instead, novice special advisers, often recruited from a tender age and seconded from corporate backgrounds, make up the backbone of the political party machines. The outsourcing of policy to think-tanks, the encirclement of Westminster by lobbyists, the revolving door and funding of the main parties all represent corporate capture of